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Care of the umbilicus and management of umbilical disorders

INTRODUCTION

At birth, the umbilical cord, which provided vascular flow between the fetus and placenta, is clamped and cut. Within the first week of life, the remnant umbilical cord stump separates from the neonate creating the umbilicus (commonly referred to as the navel).

Infection, hernia, granulomas, and congenital anomalies can occur in the umbilicus and are more commonly seen in infancy.

The care of the umbilical cord and clinical problems associated with the umbilicus will be reviewed here.

ANATOMY

Umbilical cord — The umbilical cord contains two arteries and one vein, which are surrounded and supported by gelatinous tissue called Wharton's jelly.

Thickness — At birth, the average diameter and circumference of the umbilical cord in a normal term infant is 1.5 and 3.6 cm, respectively [1,2]. Both thick and thin cords are associated with increased risk of significant pathology. (See 'Newborn examination' below.)
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References Top
  1. Moinian, M, Meyer, WW, Lind, J. Diameters of umbilical cord vessels and the weight of the cord in relation to clamping time. Am J Obstet Gynecol 1969; 105:604.
  2. Patel, D, Dawson, M, Kalyanam, P, et al. Umbilical cord circumference at birth. Am J Dis Child 1989; 143:638.
  3. Naeye, RL. Umbilical cord length: clinical significance. J Pediatr 1985; 107:278.
  4. Ananth, CV, Ovelese, Y, Yeo, L, et al. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol 2005; 192:191.
  5. Gilbert-Barness, E, Drut, RM, Drut, R, et al. Developmental abnormalities resulting in short umbilical cord. Birth Defects Orig Artic Ser 1993; 29:113.
  6. de Laat, MW, Franx, A, Bots, ML, et al. Umbilical coiling index in normal and complicated pregnancies. Obstet Gynecol 2006; 107:1049.
  7. Cullen, T. Embryology, Anatomy, and Diseases of the Umbilicus Together with Diseases of the Urachus, WB Saunders, Philadephia 1916.
  8. Coetzee, T. Clinical anatomy of the umbilicus. S Afr Med J 1980; 57:463.
  9. Friedman, JM. Umbilical dysmorphology. The importance of contemplating the belly button. Clin Genet 1985; 28:343.
  10. Wildhaber, BE, Antonelli, E, Pfister, RE. The giant umbilical cord. Arch Dis Child Fetal Neonatal Ed 2005; 90:F535.
  11. Iwasaki, I, Yu, TJ, Itahashi, K, et al. Isolated well-formed intestinal tissue in the umbilical cord. A variant of cyst of omphalomesenteric duct. Acta Pathol Jpn 1986; 36:565.
  12. Ameh, EA, Nmadu, PT. Major complications of omphalitis in neonates and infants. Pediatr Surg Int 2002; 18:413.
  13. Ueno, T, Hashimoto, H, Yokoyama, H, et al. Urachal anomalies: ultrasonography and management. J Pediatr Surg 2003; 38:1203.
  14. Bourke, WG, Clarke, TA, Mathews, TG, et al. Isolated single umbilical artery--the case for routine renal screening. Arch Dis Child 1993; 68:600.
  15. Gornall, AS, Kurinczuk, JJ, Konje, JC. Antenatal detection of a single umbilical artery: does it matter?. Prenat Diagn 2003; 23:117.
  16. Thummala, MR, Raju, TN, Langenberg, P. Isolated single umbilical artery anomaly and the risk for congenital malformations: a meta-analysis. J Pediatr Surg 1998; 33:580.
  17. Chow, JS, Benson, CB, Doubilet, PM. Frequency and nature of structural anomalies in fetuses with single umbilical arteries. J Ultrasound Med 1998; 17:765.
  18. Deshpande, SA, Jog, S, Watson, H, Gornall, A. Do babies with isolated single umbilical artery need routine postnatal renal ultrasonography?. Arch Dis Child Fetal Neonatal Ed 2009; 94:F265.
  19. Zupan, J, Garner, P, Omari, AA. Topical umbilical cord care at birth. Cochrane Database Syst Rev 2004; :CD001057.
  20. Mullany, LC, Darmstadt, GL, Khatry, SK, et al. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet 2006; 367:910.
  21. Neonatal tetanus--Montana, 1998. MMWR Morb Mortal Wkly Rep 1998; 47:928.
  22. Mullany, LC, Darmstadt, GL, Khatry, SK, et al. Impact of umbilical cord cleansing with 4.0% chlorhexidine on time to cord separation among newborns in southern Nepal: a cluster-randomized, community-based trial. Pediatrics 2006; 118:1864.
  23. Pezzati, M, Biagioli, EC, Martelli, E, et al. Umbilical cord care: the effect of eight different cord-care regimens on cord separation time and other outcomes. Biol Neonate 2002; 81:38.
  24. Wilson, CB, Ochs, HD, Almquist, J, et al. When is umbilical cord separation delayed?. J Pediatr 1985; 107:292.
  25. Razvi, S, Murphy, R, Shlasko, E, Cunningham-Rundles, C. Delayed separation of the umbilical cord attributable to urachal anomalies. Pediatrics 2001; 108:493.
  26. Vane, DW, West, KW, Grosfeld, JL. Vitelline duct anomalies. Experience with 217 childhood cases. Arch Surg 1987; 122:542.
  27. Crankson, SJ, Ahmed, GS, Palkar, V. Patent omphalomesenteric duct of the vermiform appendix in a neonate: congenital appendicoumbilical fistula. Pediatr Surg Int 1998; 14:229.
  28. Rowe, PC, Gearhart, JP. Retraction of the umbilicus during voiding as an initial sign of a urachal anomaly. Pediatrics 1993; 91:153.
  29. Cilley, R. Disorders of the umbilicus. In: Pediatric Surgery, Grosfeld, J, O'Neill, J, Coran, A, Fonkalsrud, E (Eds), Mosby Inc., Philadelphia 2006.
  30. Cilento, BG Jr, Bauer, SB, Retik, AB, et al. Urachal anomalies: defining the best diagnostic modality. Urology 1998; 52:120.
  31. Ashley, RA, Inman, BA, Routh, JC, et al. Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol 2007; 178:1615.
  32. Walker, SH. The natural history of umbilical hernia. A six-year follow up of 314 Negro children with this defect. Clin Pediatr (Phila) 1967; 6:29.
  33. Hall, DE, Roberts, KB, Charney, E. Umbilical hernia: what happens after age 5 years? J Pediatr 1981;98:415.
  34. Meier, DE, OlaOlorun, DA, Omodele, RA, et al. Incidence of umbilical hernia in African children: redefinition of "normal" and reevaluation of indications for repair. World J Surg 2001; 25:645.
  35. Katz, DA. Evaluation and management of inguinal and umbilical hernias. Pediatr Ann 2001; 30:729.
  36. Colige, A, Sieron, AL, Li, SW, et al. Human Ehlers-Danlos syndrome type VII C and bovine dermatosparaxis are caused by mutations in the procollagen I N-proteinase gene. Am J Hum Genet 1999; 65:308.
  37. Young, ID, Harper, PS. The natural history of the severe form of Hunter's syndrome: a study based on 52 cases. Dev Med Child Neurol 1983; 25:481.
  38. LaFranchi, SH, Murphey, WH, Foley, TP Jr, et al. Neonatal hypothyroidism detected by the Northwest Regional Screening Program. Pediatrics 1979; 63:180.
  39. Tank, ES, Hatch, DA. Hernias complicating chronic ambulatory peritoneal dialysis in children. J Pediatr Surg 1986; 21:41.
  40. Blumberg, NA. Infantile umbilical hernia. Surg Gynecol Obstet 1980; 150:187.
  41. Papagrigoriadis, S, Browse, DJ, Howard, ER. Incarceration of umbilical hernias in children: a rare but important complication. Pediatr Surg Int 1998; 14:231.
  42. Okada, T, Yoshida, H, Iwai, J, et al. Strangulated umbilical hernia in a child: report of a case. Surg Today 2001; 31:546.
  43. Pomeranz, A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin North Am 2004; 51:819.
  44. Sheth, SS, Malpani, A. The management of umbilical granulomas with cryocautery. Am J Dis Child 1990; 144:146.
  45. Larralde de, Luna M, Cicioni, V, Herrera, A, et al. Umbilical polyps. Pediatr Dermatol 1987; 4:341.
  46. Oguzkurt, P, Kotiloglu, E, Tanyel, FC, Hicsonmez, A. Umbilical polyp originating from urachal remnants. Turk J Pediatr 1996; 38:371.
  47. Avolio, L, Cerritello, A, Verga, L. Heterotopic pancreatic tissue at umbilicus. Eur J Pediatr Surg 1998; 8:373.
  48. Ito, F, Ando, H, Watanabe, Y, et al. An accessory lobe of the liver disturbing closure of the umbilical ring. Pediatr Surg Int 1999; 15:394.
  49. Skinner, MA, Grosfeld JL. Inguinal and umbilical hernia repair in infants and children. Surg Clin North Am 1993; 73:439.
  50. Veloso, FT, Cardoso, V, Fraga, J, et al. Spontaneous umbilical fistula in Crohn's disease. J Clin Gastroenterol 1989; 11:197.
  51. Cushing, AH. Omphalitis: a review. Pediatr Infect Dis 1985; 4:282.
  52. Rotimi, VO, Duerden, BI. The development of the bacterial flora in normal neonates. J Med Microbiol 1981; 14:51.
  53. Harnden, A, Lennon, D. Serious suppurative group A streptococcal infections in previously well children. Pediatr Infect Dis J 1988; 7:714.
  54. McKenna, H, Johnson, D. Bacteria in neonatal omphalitis. Pathology 1977; 9:111.
  55. Sawardekar, KP. Changing spectrum of neonatal omphalitis. Pediatr Infect Dis J 2004; 23:22.
  56. Davies, EG, Isaacs, D, Levinsky, RJ. Defective immune interferon production and natural killer activity associated with poor neutrophil mobility and delayed umbilical cord separation. Clin Exp Immunol 1982; 50:454.
  57. Mason, WH, Andrews, R, Ross, LA, Wright, HT Jr. Omphalitis in the newborn infant. Pediatr Infect Dis J 1989; 8:521.
  58. Hayward, AR, Harvey, BA, Leonard, J, et al. Delayed separation of the umbilical cord, widespread infections, and defective neutrophil mobility. Lancet 1979; 1:1099.
  59. Guvenc, H, Aygun, AD, Yasar, F, et al. Omphalitis in term and preterm appropriate for gestational age and small for gestational age infants. J Trop Pediatr 1997; 43:368.
  60. Chamberlain, JW. Omphalitis in the newborn. J Pediatr 1936; 9:215.
  61. Brook, I. Bacteriology of neonatal omphalitis. J Infect 1982; 5:127.
  62. Faridi, MM, Rattan, A, Ahmad, SH. Omphalitis neonatorum. J Indian Med Assoc 1993; 91:283.
  63. Brook, I. Cutaneous and subcutaneous infections in newborns due to anaerobic bacteria. J Perinat Med 2002; 30:197.
  64. Hsieh, WS, Yang, PH, Chao, HC, Lai, JY. Neonatal necrotizing fasciitis: a report of three cases and review of the literature. Pediatrics 1999; 103:e53.
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